Universal attachment for an orthodontic aligner

ABSTRACT

A universal attachment device configured to be secured to a tooth for engagement with a removable dental positioning appliance including a base including a lateral surface including a plurality of faces for effecting a plurality of repositioning forces on a tooth, wherein when the device is engaged with the appliance and when the base is secured to the tooth, one of the repositioning forces is effected upon the tooth and at least one of the other repositioning forces are not effected upon the tooth. A method of using the device is also disclosed.

BACKGROUND Technical Field

The present disclosure relates generally to orthodontic aligners, andmore particularly to attachments for securing orthodontic aligners toteeth.

Description of the Related Art

Orthodontics is the practice of manipulating a patient's teeth toimprove the appearance and function of the teeth. Removable toothpositioning appliances (invisible braces), such as clear plasticaligners and retainers that tightly fit over teeth are commonly used inorthodontic treatments as an alternative to braces and other bondedorthodontic equipment for controlled tooth movement to a pre-determinedposition. Various systems and methods for positioning teeth have beendevised. For example, systems and methods for positioning are disclosedin U.S. Pat. Nos. 6,309,215; 6,450,807; and 7,121,825, which areassigned to Align Technology, Inc., the contents of which are herebyincorporated by references.

As shown in FIG. 1, a skull 10 has a lower jawbone 20 having a lower jaw100 and an upper jawbone 22 having an upper jaw 101. Each of the lowerjaw 100 and the upper jaw 101 include teeth 102. A joint 30 known as thetemporal mandibular joint (TMJ) make it possible to open and close one'smouth. As the external auditory meatus 31 which is the exterior of theear canal is separated from the TMJ 30 by a bony anterior wall ofvariable thickness, injuries to the TMJ 30 often result in pain ordiscomfort being felt in one's ears. Thus, an uneven or misaligned bitecan cause TMJ disorders that cause pain and discomfort in one's jaw andin one's ears. Accordingly, it is desirable to correct the alignment ofteeth so as to ensure a proper fight and to minimize the likelihood ofpain and discomfort that may result from the misalignment of teeth.

As shown in FIG. 2A, the lower jaw 100 includes teeth 102 that may bemoved from an initial tooth arrangement to a final tooth arrangement. Asa frame of reference to describe how a tooth may be moved, an arbitrarycenterline CL may be drawn through the tooth 102. With reference to thecenterline CL, each tooth 102 may be moved in orthogonal directions withrespect to the center line CL as represented by axes 104, 106, and 108(where 104 is the centerline). To effect root angulation of the tooth102, a force applied as indicated by directional arrow 110 about axis108 may be applied to the tooth. To effect a torque on the tooth 102, aforce applied as indicated by directional arrow 113 about axis 106 maybe applied to the tooth 102. To effect a rotation upon the tooth 102, aforce as indicated by directional arrow 112 about axis 104 may beapplied to the tooth 102. It is to be understood that the direction ofthe forces to effect root angulation, torque, and rotation would varydepending on the location of the tooth within the mouth as the teeth 102are disposed along a rounded jaw. In addition, the tooth 102 may beintruded (pushed deeper into the gum) or extruded (partial displacementout of its socket away from the gum) when the tooth is moved ortranslated along axis 104 or its centerline CL. Thus, all possiblefree-form motions of the tooth 102 can be performed.

FIG. 2B shows how the magnitude of any tooth movement may be defined interms of a maximum linear translation of any point P on a tooth 102.Each point P₁ will undergo a cumulative translation as that tooth ismoved in any of the orthogonal or rotational directions defined in FIG.2A. That is, while the point will usually follow a nonlinear path, thereis a linear distance between any point in the tooth when determined atany two times during the treatment. Thus, an arbitrary point P₁ may infact undergo a true side-to-side translation as indicated by arrow d₁,while a second arbitration point P₂ may travel along an arcuate path,resulting in a final translation d₂.

FIG. 2C shows a prior art adjustment appliance 11 that is worn by thepatient in order to achieve an incremental repositioning of individualteeth in the jaw as described generally above. Conventionally, theappliance is a polymeric shell that has a teeth receiving cavity. As setforth in the prior applications, each polymeric shell may be configuredso that its tooth receiving cavity has a geometry corresponding to anintermediate or final tooth arrangement intended for the appliance. Thepatient's teeth are repositioned from their initial tooth arrangement toa final tooth arrangement by placing a series of incremental positionadjustment appliances over the patient's teeth. The adjustmentappliances are generated at the beginning of the treatment, and thepatient wears each appliance until the pressure of each appliance on theteeth can no longer be felt. At that point, the patient replaces thecurrent adjustment appliance with the next adjustment appliance in theseries until no more appliance remains. Conveniently, the appliances aregenerally not affixed to the teeth and the patient may place and replacethe appliances at any time during the procedure. The final appliance orseveral appliances in the series may have a geometry or geometriesselected to overcorrect the tooth arrangement, i.e., have a geometrywhich would (if fully achieved) move individual teeth beyond the tootharrangement which has been selected as the final desired position of theteeth. Such overcorrection may be desirable in order to offset potentialrelapse after the repositioning method has been terminated, i.e., topermit some movement of individual teeth back toward their pre-correctedpositions. Overcorrection may also be beneficial to speed the rate ofcorrection, i.e., by having an appliance with a geometry that ispositioned beyond a desired intermediate or final position, theindividual teeth will be shifted toward the position at a greater rate.In such cases, the use of an appliance can be terminated before theteeth reach the positions defined by the appliance.

The polymeric shell 111 can fit over all teeth present in the upper orlower jaw. Often, only certain one(s) of the teeth will be repositionedwhile others of the teeth will provide a base or an anchor region forholding the appliance 111 in place as the appliance 111 applies aresilient repositioning force against the tooth or teeth to berepositioned. In complex cases, however, multiple teeth may berepositioned at some point during the treatment. In such cases, theteeth which are moved can also serve as a base or anchor region forholding the repositioning appliance. Appliance 111 is referred to hereininterchangeably as a polymeric shell or a dental positioning applianceor as an aligner or as an appliance.

The polymeric appliance 111 of FIG. 2C may be formed from a thin sheetof a suitable elastomeric polymer, such as Tru-Tain 0.03 in, thermalforming dental material, available from Tru-Tain Plastics, Rochester,Minn. Usually, no wires or other means will be provided for holding theappliance in place over the teeth. In some cases, however, it will bedesirable or necessary to provide individual anchors on teeth withcorresponding receptacles or apertures in the appliance 100 so that theappliance can apply an upward force on the tooth which would not bepossible in the absence of such an anchor. The polymeric appliance 111is more generally referred to as an aligner.

Initially, when placed on teeth, the appliance 111 is ill-fittingbecause it is shaped to fit the alignment that the teeth need to be atthe end of the treatment period, e.g., 2 weeks. It should be noted thatseveral treatment periods may be required to move the teeth into theirultimate desired positions with each of the treatment periodsincrementally moving the teeth toward the desired positions for theteeth. The misfit of the aligner or appliance 111 with respect to theteeth is what urges the teeth to move toward being in alignment with theshape of the appliance 111. Gradually, the teeth adjust to approximatethe shape of aligner or appliance 111 such that it will fit the teethwell as the alignment of the teeth for that stage has been achieved. Inother words, several aligners or appliances 111 may have to be cast foreach stage of a series of stages that collectively will be used tostraighten the teeth. At each stage, the tooth movement may be in therange of 0.25 to 0.33 mm. While each stage may seem to be a small amountof movement, after a number (e.g., 10-30) aligners have been worn, thetotal amount of tooth movement may be substantial.

The movement of teeth by plastic aligners may start with capturing thecurrent tooth positions by representing them digitally for manipulationto correct a malocclusion. A digital model is fabricated through anintraoral scan, or other true-to-size representation of a person'smalocclusion (malocclusion is tooth or jaw tooth relationship thatdeviates from normal in any plane of space). First, each tooth isdigitally sectioned into its own entity to allow for movement andcollision detection in the software. Next, all the teeth areincrementally moved, depending on the plane of space, by 0.1 mm-0.2 mmper “stage” and ultimately through many stages to their destination atthe ideal endpoint. Each increment is represented by a digital model;usually an STL file that is 3D printed, there are usually 40-50increments (commonly referred to as stages). These models are then usedto fabricate an aligner by vacuum-forming a plastic tray to that model.When the teeth in the mouth are at time point 0, they will wear analigner designed to the digital tooth position (stage) at time point 1(the next time point). The aligner is thus providing a force to theteeth—as it is fabricated for a position the teeth are not currentlyoccupying (about 0.1 mm different in every plane of space as needed).The stretch of the plastic of which aligner is fabricated allows thealigner to seat on the existing tooth position by elastically distortingto the current location/orientation/shape of the tooth from itsfabricated shape. The material memory within the plastic trying toreform to its fabricated shape is what applies the force to the teethfor movement. Thus, the aligners need undercuts or retentive faces topress against or they will resume their fabricated shape withoutapplying a force to the tooth. This process is repeated, usually on aweekly basis, until the teeth are the final time point or stage. In turnthat aligner moves the teeth incrementally from one stage to the next.

ALIGN TECHNOLOGY's INVISALIGN's CLINCHECK software determines whichteeth require the placement of attachments. This determination, as wellas the determination of the shape and configuration of the attachment,is conventionally performed prior to securing any attachments to anyteeth. In particular, dental impressions are taken and technicians mayperform a digital scan of the dental impressions using a computedtomography (CT) scanner to generate a 3-dimensional model of the upperand lower teeth. Once the virtual modeling of your teeth has beencompleted and your prescription form has been evaluated, an Invisalign®technician will create an on-screen animation showing a proposedtreatment plan for your case (sequence of tooth movements that can givethe results that your dentist has requested). ALIGN TECHNOLOGY'sINVISALIGN's CLINCHECK software animates and simulates the treatment tobe performed. The software provides digital information to generate apair of aligners for the upper and lower teeth for each stage of thetreatment plan.

Typically, and especially with INVISALIGN aligners which more closelyapproximate the patient's gumline, teeth are poorly shaped for suchaligners to move them. Thus, in most cases, the use of attachments orattachment devices is required. For example, some types of alignmentchanges are difficult to accomplish with removable braces. It might bethat the needed movement itself creates the challenge, such as rotatinga tooth or extruding it (bringing more of it above the gum line). Inother cases, some characteristic of a tooth (size, shape, angulation)may make it difficult for the aligner to apply pressure to it. In suchsituations, the use of an attachment may achieve the desired results. Inparticular, the attachment provides an anchor point that helps directthe forces of the aligner more effectively and predictably to the tooth.Front teeth tend to intrude into the gums away from the aligner due totheir wedge shape—making them lose “track” during treatment. Posteriorteeth resist rotation due to their round form as there is nothing forthe aligner to grip on rounder teeth. This is much like trying to grip adoorknob that is round when your hands are wet: if that doorknob was inthe shape of a star, or bar, you would be able to grab it, even with wethands, and turn the knob. They resist extrusion due to lack ofappropriate retentive areas and they resist intrusion because theextrusive counterforce is not transmitted well to the adjacent teeth dueto their morphology as previously described. Currently, theseshortcomings of three-dimensional tooth control have be mostly overcomeby designing customized “attachments” for the teeth. An attachment willprovide a pushing surface perpendicular to the surface of the tooth(much like adding triangles to a flat round doorknob to allow for a starshape, letting your fingers grip into a retentive area) to allow thealigner design to press against the attachment, and not just the anatomyof the tooth, therefore increasing efficiency and control.

Conventionally, a template for creating the attachments is made from thedigitized scan of the teeth. Such a template looks similar to a regularaligner with the exception that it has small bulges in it thatcorrespond to specific locations, on specific teeth, where yourattachments need to be placed. The bulges in the template are filled inwith tooth-colored dental bonding (dental composite). The shape of thebulge creates the shape of the attachment being placed (rectangular,square triangle, round, ellipsoid). Once the bonding cures and hardens,the template is removed and the small bump of bonding that remains isthe “attachment”. Although the dentist attempts to remove excessmaterial, the exact size and dimensions of the attachment are invariablyslightly different than that determined by the by the ALIGN TECHNOLOGY'sINVISALIGN's CLINCHECK software and the mold of the template. This isbecause some excess material or flash is likely to remain despite thedentist's attempts to remove the material. As the purpose of thealigner, at each stage, is to gently move the teeth by moving the teethby small incremental amounts, the remaining excess material mayinterfere with the fit of the aligner and the results may besub-optimal.

Attachments are placed at specific locations on specific teeth, and mayhave rectangular, square, circular, ellipsoidal, or triangular shapes.The specific shape and orientation is dictated by the specific purposeit serves. That is, the shape and orientation of the attachment isdetermined based on what movement (e.g., tooth rotation, translation,intrusion or extrusion) of the tooth is desired. For example, anellipsoidal (oval) attachment might measure about 1/16th of an inchwide, a little more than that in height, and roughly 1/32nd inches thick(about the same thickness as a credit card). Also for example, arectangular attachment that may be 1/16th of an inch thick verticallyaligned rectangular attachments may be placed on teeth to assist withtranslation (moving into an adjacent space), tipping, torquing orrotational movements. In another example, a 1/16th of an inch-thickhorizontal beveled rectangular attachments may be used to aid withintrusive (pushing in) or extrusive (pulling out) tooth movements.

Attachment devices, conventionally, can also be rectangular orwedge-shaped. When the attachment is rectangular, the alignment of theappliance and the attachment is important because unless properlyaligned, the appliance will not be able to placed onto the attachmentdue to the limit in the elasticity of the aligning tray. Wedge-shapedattachments are more forgiving because even if the shape is slightlyoff, the wedge-shaped appliance would tend to slide somewhat into placeinto the corresponding indentation of the appliance.

Referring to FIG. 3, an attachment device 200 is shown bonded to a tooth102 above the gingiva G. The attachment device 200 typically includes anattachment body 201 which is bonded to the tooth 102 with a bonding 201.While preferably, the bonding 201 does not extend past the back surfaceof the attachment body 201 that contacts the tooth 102, often thebonding 201 will have some flash and cover more tooth surface than thesurface area of the attachment body 201. The appliance 111 is configuredto accommodate the shape of the attachment 200 such that when worn, theappliance 111 urges the attachment 200 to move the tooth 102 toward adesired position when an optimal force is applied for a sufficientduration of time for a particular stage of the treatment to achieve thedesired tooth movements.

For example, as shown in FIG. 4, an appliance 300 that is substantiallysimilar to the appliance 111 is shown, except that it also includes anegative impression 302 to accommodate the attachment device 200. Thealigner or appliance 300 applies repositioning forces to the attachmentdevice 100 that causes the tooth 102 to which the attachment device 100is bonded to move toward the ultimate desired position. Attachmentdevices, such as attachment device 200, allows the aligner a morepositive grasp on the tooth.

FIG. 5 illustrates conventional attachments A that are bonded to teeth102. Conventional attachments are generally selected from two shapes,namely, cubes or rectangular prisms that can be oriented so that theyare “beveled” in a desired direction to have a longer face in a givenorientation. Each of the attachments A would require a correspondingnegative impression 302 on the aligner or appliance 300 to accommodatethe attachment A and to apply a force against the attachment A to movein a desired manner.

When the appliance 300 is placed onto the teeth 102, it appliescontrolled forces to the teeth 102 as it applies a force against theattachment devices 200 bonded to the teeth 102. For this to beaccomplished, conventionally, a high degree of precision is needed suchthat the attachment device 200 and the appliance 300 are shaped andpositioned relative to one another such that when the appliance 300 isplaced upon the teeth 102, the appliance 300 snuggly fits and engagesthe attachment device 200. Conventionally, therefore, the margin oferror for the relative positioning of the appliance 300 and theattachment device are thus low. In addition to precise placement, eachattachment device 200 must have a customized shape so that it can engagethe indented structure of the appliance 300. If the shape and positionof the attachment device 200 is not correct, then the appliance 300 willnot be able to be placed atop the teeth 102. It is noted that theappliance 300 has a shape that may be slightly different from that ofthe teeth 102 on which the appliance 300 is to be placed but not sodifferent as to prevent the placement of the appliance 300 thereon.Rather, the flexibility of the appliance 300 permits placement of theappliance 300 onto the teeth 102 and the slight difference on theconfiguration of the appliance 300 relative to the teeth 102 applies agentle force to the teeth 102 that over time causes the teeth 102 tomove into a desired corrected position.

Since both the shape and position of the attachment devices 200 requirea high degree of customization, the amount of time that is taken by theclinician, setting up the tooth movements at the computer isconsiderable. Further, conventionally, the placement of the attachmentdevices 200 occurs after computer modeling of the teeth has occurred.Such computer modeling is used to determine the configuration of theappliance. While the computer modeling attempts to account for theattachment devices when modeling the teeth, it is up to the clinician tochoose the shape, size, and orientation of the attachments on thecomputerized treatment plan, this is a time consuming and difficultprocess. Bonding material that is used to secure the attachment device200 to a tooth 102 will necessarily cause some error in such modelingbecause of a phenomenon known as ‘flash’ in which some of the bondingmaterial moves into areas adjacent to what is being attached. Thissometimes results from an excess of bonding material being used. Theflash generated displaces the aligner from the tooth, altering how andwhere the aligner will contact the tooth because the flash provides asurface not accounted for by the computer prediction from which thealigning trays are fabricated. As the aligning trays enact onnon-captured surfaces, unintentional tooth movements can and do oftenoccur.

Conventionally, until the computer modeling is created, the attachmentdevices 200 cannot be secured to the teeth 102 as the configuration ofthe attachment device 200 has yet to be determined. Accordingly, thecomputer models do not account for slight varying features that mightexist whether from slight errors in the placement of the attachments orflash or excess bonding material changing the resulting shape of theteeth when the attachments are secured to the teeth. Because theattachment presented here is placed on the teeth prior to the digitalscan or impression of the teeth used to fabricate the treatmentaligners, any flash produced is accounted for in the scan and in thesubsequent treatment aligners. The reason this attachment can be placedprior to the scan is because it supports tooth movement in all planes,something no other attachment does and thus no other attachment can beplaced prior to a digital scan or impression.

It should be understood that nothing in the background section shall beconstrued as an admission of prior art unless otherwise noted and theexamples that were discussed have been provided so as to provide abetter understanding of the problems addressed by the current invention.

SUMMARY

As will be discussed in greater detail herein, the present disclosureadvantageously provides a universal attachment member that can be bondedor otherwise secured to teeth with little consideration of the finaldesired tooth positioning. Instead, the same universal attachment membercan be used and positioned in the same way relative to the lateral toothsurfaces regardless how the appliance is configured to apply forces tourge the teeth to desired positions. This is an advantageous feature ascomparted to conventional attachment configurations and shapes which arechosen and placed on the teeth in the digital treatment plan for aspecific tooth movement. In contrast, conventional attachments onlyprovide adequate leverage for movements in one or two planes of space.

A universal attachment device may be configured to be secured to a toothfor engagement with a removable dental positioning appliance including abase including a lateral surface including a plurality of faces foreffecting a plurality of repositioning forces on a tooth, wherein whenthe device is engaged with the appliance and when the base is secured tothe tooth, one of the repositioning forces is effected upon the toothand at least one of the other repositioning forces are not effected uponthe tooth.

In an embodiment, a universal attachment device may be configured to besecured to a tooth for engagement with a removable dental positioningappliance. The universal attachment device may include: a mountingsurface configured to be secured to the tooth; and an attachmentsurface, the attachment surface generally opposing the mounting surfaceand including a plurality of movement faces, each of the plurality ofmovement faces being configured to interact with the removable dentalpositioning appliance, the interaction of the removable dental appliancewith each of the plurality of movement faces effecting a force upon eachof the movement faces, the force having a magnitude and a direction,wherein at least one of the movement faces interacts with the removabledental appliance such that the force applied to the at least one of themovement faces has a magnitude that is substantially zero and at leastanother one of the movement faces interacts with the removable dentalappliance such that the force applied to the at least another one of themovement faces has a magnitude that is greater than zero. An applicationof a combination of forces upon particular ones of the plurality ofmovement faces may result in a net force upon the tooth to effect adesired repositioning movement of the tooth when the attachment deviceis attached to the tooth and the removable dental positioned applianceis engaged with the attachment device. The attachment surface may begenerally planar and each of the movement faces is angled with respectto the attachment surface.

The universal attachment device may include a first prism that isdefined by at least a first portion of the plurality of movement faces.The universal attachment device may include a second prism that isdefined by at least a second portion of the plurality of movement faces.The first prism and the second prism may define a 45-degree angletherebetween and define a V-shape, the first prism and the second prismhaving a common first end, each of the first prism and the second prismextending lengthwise from the common first end. The first and secondprisms may be symmetrically disposed relative to one another along anaxis bisecting a side of the mounting surface. The mounting surface maybe configured as a rectangular shape, and preferably may have a squareshape. However, the mounting surface may have any suitable shapeprovided that it supports the movement faces of the prisms describedherein and facilitates securing the prisms to the lateral surfaces ofthe teeth. Each of the first prism and the second prism include three ofthe plurality of movement faces, each of the movement faces of the firstand second prisms being angled relative to one another.

A universal attachment device may include a V-shaped prism. The V-shapedprism may include: a first movement face and a second movement face, thefirst and second movement faces extending along a first axis, the firstmovement face and the second movement face being angled with respect toone another; a third movement face and a fourth movement face, the thirdand fourth movement faces extending along a second axis, the thirdmovement face and the fourth movement face being angled with respect toone another, the first axis and the second axis defining an angletherebetween; a fifth movement face, the fifth movement face beingdisposed at a first end of the V-shaped prism, the fourth movement facebeing angled with respect to first and second movement faces; and asixth movement face, the sixth movement face being disposed at a secondend of the V-shaped prism, the first and second ends of the V-shapedprism being symmetrically positioned with respect to an axis bisectingthe V-shaped prism, the sixth movement face being angled with respect tothe third and fourth movement faces.

Also disclosed is a method of using the disclosed universal attachmentdevices. The method may include: providing a universal attachmentdevice, comprising: a V-shaped prism, which may include: a firstmovement face and a second movement face, the first and second movementfaces extending along a first axis, the first movement face and thesecond movement face being angled with respect to one another; a thirdmovement face and a fourth movement face, the third and fourth movementfaces extending along a second axis, the third movement face and thefourth movement face being angled with respect to one another, the firstaxis and the second axis defining an angle therebetween; a fifthmovement face, the fifth movement face being disposed at a first end ofthe V-shaped prism, the fourth movement face being angled with respectto first and second movement faces; and a sixth movement face, the sixthmovement face being disposed at a second end of the V-shaped prism, thefirst and second ends of the V-shaped prism being symmetricallypositioned with respect to an axis bisecting the V-shaped prism, thesixth movement face being angled with respect to the third and fourthmovement faces

The method may also include affixing the universal attachment device toa tooth; and determining a combination of the first movement face, thesecond movement face, the third movement face, the fourth movement face,the fifth movement face, and the sixth movement face to which to apply aforce to effect a tooth movement. The combination of the movement facesthat is determined may effect or result in different tooth positioningcorrections, which may include but are not limited to: extrusion,intrusion, lateral movement, rotation, root angulation, and/or crownangulation. Preferably, the step of determining may occur after the stepof affixing.

The above and other aspects, features and advantages of the presentdisclosure will become apparent from the following description read inconjunction with the accompanying drawings, in which like referencenumerals designate the same elements.

BRIEF DESCRIPTION OF THE DRAWINGS

A further understanding of the present disclosure can be obtained byreference to a preferred embodiment set forth in the illustrations ofthe accompanying drawings. Although the illustrated preferred embodimentis merely exemplary of methods, structures and compositions for carryingout the present disclosure, both the organization and method of thedisclosure, in general, together with further objectives and advantagesthereof, may be more easily understood by reference to the drawings andthe following description. The drawings are not intended to limit thescope of this disclosure, which is set forth with particularity in theclaims as appended or as subsequently amended, but merely to clarify andexemplify the disclosure.

For a more complete understanding of the present disclosure, referenceis now made to the following drawings in which:

FIG. 1 is an elevational diagram showing the anatomical relationship ofthe jaws of a patient.

FIG. 2A illustrates in more detail the patient's lower jaw and providesa general indication of how teeth may be moved by the methods andapparatus of the present invention.

FIG. 2B illustrates a single tooth from FIG. 2A and defines how toothmovement distances are determined.

FIG. 2C illustrates the jaw of FIG. 2A together with an incrementalposition adjustment appliance which has been configured according to themethods and apparatus of the present invention.

FIG. 3 illustrates a tooth that has an attachment device bonded thereon.

FIG. 4 illustrates the attachment device of FIG. 3 bonded to one ofteeth and an appliance having corresponding mating feature being securedto the teeth.

FIG. 5 discloses a variety of attachment devices that have been bondedto teeth at various orientations relative to the teeth.

FIG. 6 illustrates an attachment device in accordance with the presentdisclosure.

FIGS. 7-15 illustrate the attachment device of FIG. 6 in use.

DETAILED DESCRIPTION

As required, a detailed illustrative embodiment of the presentdisclosure is disclosed herein. However, techniques, systems,compositions and operating structures in accordance with the presentdisclosure may be embodied in a wide variety of sizes, shapes, forms andmodes, some of which may be quite different from those in the disclosedembodiment. Consequently, the specific structural and functional detailsdisclosed herein are merely representative, yet in that regard, they aredeemed to afford the best embodiment for purposes of disclosure and toprovide a basis for the claims herein, which define the scope of thepresent disclosure.

Reference will now be made in detail to several embodiments of thedisclosure that are illustrated in the accompanying drawings. Whereverpossible, same or similar reference numerals are used in the drawingsand the description to refer to the same or like parts or steps. Thedrawings are in simplified form and are not to precise scale. Forpurposes of convenience and clarity only, directional terms, such astop, bottom, up, down, over, above, below, etc., or motional terms, suchas forward, back, sideways, transverse, etc. may be used with respect tothe drawings. These and similar directional terms should not beconstrued to limit the scope of the disclosure in any manner.

Referring to FIG. 6, an attachment device 400 is described.Advantageously, the attachment device 400 is prefabricated and designedto capture the aligner pushing vector in all planes of space and mostimportantly allows for “forgiveness” in all planes of space due to themultiple planes or faces that the device 400 includes. In contrast, whena traditional attachment is oriented with a perfectly perpendicular faceagainst the direction of tooth movement, it offers maximum surface areafor the pushing vector from the aligner but if the aligner does not seatperfectly or the biology of the teeth causes errors in tracking duringtreatment, the aligner itself will cause iatrogenic tooth movement, ifthe pushing face of an aligner skips, or moves beyond that perpendicularface and onto the beveled face, the tooth will move in the oppositedirection as intended. This problem has been addressed by manypractitioners by using the beveled surface on the side from which onewishes to use the pushing force. The drawback of this method is thesurface area available for the pushing force is decreased but what isgained is a buffer room for force application area during aligner wear.The attachment designed here is truly multi-planer without sacrificingsurface area. This attachment allows for both maximum pushing surfacearea and allows for aligner forgiveness in all planes of space.

Further, because the attachment device 400 can be used to repositionteeth in a multitude of ways, as the attachment device 400 includesmultiple surfaces at least one of which is likely to be engagable withthe appropriate indentation or shape on the aligner, the attachmentdevice 400 can be secured to the teeth without taking into considerationwhich one of its faces or surfaces is to be utilized. Thus, theattachment device 400 can be pre-formed or pre-fabricated and secured tothe teeth prior to determining the precise repositioning that is neededfor each tooth. In contrast, this would otherwise only be achievable bya particularly purposed attachment that would need to be are designedwith software on the digital model after the scan. This means theoperator receives an initial aligner to use to deliver the attachmentsto the teeth for micro-mechanical bonding methods. Dental composite isplaced into the wells/positive space for the attachments and then thealigner is seated on the teeth and the composite is thencured/polymerized to the tooth with light initiation of the chemicalreaction.

This process has several drawbacks. Firstly, when delivering theattachments there is inevitably the creation of flash, or excesscomposite in a thin layer that dispels from the area of attachmentdelivery. Even with the most diligent cleanup with delivery of theattachment, some flash will remain. This flash will distort the seatingof the aligner to the tooth surface and hinder accuracy and tracking ofthe teeth through treatment. This is because, conventionally, it simplycannot be accounted for during the initial treatment planning, as theteeth are scanned and models fabricated prior to the actual attachmentdelivery. Secondly, dental composites shrink and pull toward theirphoto-initiation point as they polymerize. This means they pull awayfrom the tooth surface and leave the potential for voids or inadequatefill of the composite into the attachment template. Any distortion ofthe attachments during delivery is not accounted for in the followingtreatment trays as the attachments were added digitally prior to thestart of treatment.

As already discussed with respect to FIG. 5, conventional attachmentsare generally selected from two shapes, namely, cubes or rectangularprisms that can be oriented so that they are “beveled” in a desireddirection to have a longer face in a given orientation. They need to beoriented as such the beveled portion of the attachment is facingopposite the direction of force application, allowing the beveledsurface to be “pressed” on by the aligner. The clinician will place,shape, and orient the attachments using the software to optimizeretention and force application. This process takes anywhere from 10 to60 plus minutes.

Advantageously, in accordance with the present disclosure, having auniversal attachment that can be easily placed on any tooth, that ismulti-planar in nature with regard to capturing force application,completely removes the need for any attachment-design planning with thesoftware. As discussed, the slight misfit of an aligner appliance withan attachment device causes a gentle urging of a tooth in a desireddirection. To that end, such a slight misfit of a fabricated aligner,e.g., aligner appliance 300, and the attachment device 400 will be withrespect to the surfaces of the attachment device 400 that are determinedto require forces applied thereto to effect desired movements; however,the appliance 300 would be configured to fit properly with respect tothe other surfaces of the appliance 300 and the tooth surfaces thatshould not have forces applied thereto to achieve the desired toothmovement.

Another advantage is that by scanning/impressing teeth that already haveattachments on them in accordance with the present disclosure, thealigner appliances that are fabricated will have the most intimate fitpossible without the risk of distortion during delivery because thetooth and the attachment secured thereto in its final configuration andorientation was taken into account when fabricating the aligner devices.It is to be understood that the attachment devices 400 may be used inconjunction with conventional aligner appliances such as those discussedabove with reference to appliance 300.

The attachment device 400 includes a base 401 that is configured to besecured, e.g., bonded, to lateral surfaces of teeth 102. The securingand bonding of the attachment device 400 to the teeth may be performedutilizing conventional bonding methods known in the art. The base 401may be generally square shaped and may include a plurality of surfacesdisposed on the surface of the base 401. Generally, the device includesa first prism P1 and a second prism P2 that are symmetrically disposedrelative to one another along axis V1. The prisms P1 and P2 may beelongated triangular prisms meeting at the center point at the edge of aface at one side of the bracket pad. The triangular prisms have theirtwo faces beveled at 45 degrees from the base, converging at the apex.The attachment will function in a very similar manner if the point ofthe converging prisms is oriented up toward the cusp of the tooth ordown toward the gums. Regardless of the direction of tooth movement, theattachment can be oriented in almost any direction and it still providestwo beveled faces for force application.

The surfaces of the prisms P1 and P2 are configured to engagecorresponding structures of an orthodontic aligner. The surfaces maygenerally form a V-shape and a centerline V1-V1 bisecting the attachmentdevice 400 may symmetrically divide the attachment device 400. Thesurfaces formed on the attachment device 400 may be beveled relative toan upper surface 401A of the base 401 may be beveled or angled relativeto the upper surface 401A at substantially 45-degree angles. Moreover,the surfaces may together generally form a V-shape and the highestpoints of the beveled surfaces relative to the upper surface 401A of thebase 401 may be along lines V4 and V5 which may define a 45-degree angletherebetween. Movement faces or beveled surfaces 404A, 404B, 406A, and406B may be defined between lines V4 and V5 and respective axes V2, V3,V6, and V7 that are defined between those surfaces and the juncture withthe upper surface 401A. Axes V2, V4 and V6 may be generally parallel andaxes V3, V5, and V7 may be generally parallel. A surface 404A may bedefined between axes V4 and V6 and may be angled at substantially 45degrees relative to the upper surface 401A. A surface 406A may bedefined between axes V2 and V4 and may be angled at substantially 45degrees relative to the upper surface 401A. A surface 404B may bedefined between axes V5 and V7 and may be angled at substantially 45degrees relative to the upper surface 401A. A surface 406B may bedefined between axes V3 and V5 and may be angled at substantially 45degrees relative to the upper surface 401A. A surface 404B may bedefined between axes V5 and V7 and may be angled at substantially 45degrees relative to the upper surface 401A. In addition, at opposingcorners symmetrical relative to axis V1, surfaces 403A and 404B may bedisposed. The surface 403A may taper downward from a height defined byaxis V4 at a 45-degree slope toward the corner of the square uppersurface 401A. The surface 403B may taper downward from a height definedby axis V5 and downward at a 45-degree slope toward the corner of thesquare upper surface 401A.

The base 401 may have a thickness T that may be 0.1 mm and the axes V4and V5 may be at a height of 2.5 mm relative to the upper surface 401A.The base 401 may be square shaped having sides that are 3-5 mm in sizedepending on the size of the teeth. The tooth contacting surface of thebase 401 may be roughened for enhanced mechanical retention whenbonding. The relatively thin thickness T of 0.1 mm, for example, allowsfor common bracket forceps to be used to deliver the universalattachment to the tooth. A large base also allows for easy applicationof bonding materials to the underside of the attachment. Again, thereare no prefabricated aligner attachments on the market and traditionalattachments are delivered by filling the negative space within analigning tray as described before.

As shown in FIGS. 7-9, the surfaces 404A, 406A, 404B and 406B maygenerally form a “V-shape” and when placed upon and secured to thetooth, the “V-shape” may be upright, or any orientation.

During use, as shown in FIGS. 7-15, the multi-planar surfaces providevarious surfaces on which an appliance or aligner B (which may besubstantially similar to the aligners 111 and 300 described above) canengage with the attachment device 400 to effect a desired force upon thetooth 102 to which the attachment device 400 is secured. The attachmentdevice 400 is universal and can be set on a tooth surface prior to adetermination of the particular force that is desired to be exerted uponthe tooth 102. This means that the attachment device 400 can be securedor bonded to the tooth 102 and the modeling can be made afterward. Thisincreases accuracy because computer modeling often will not accountadequately for such things as flash from excess bonding material used tobond conventional attachments to teeth, even if the computer model couldaccount for the attachment itself. In addition, unlike the rectangularattachments discussed above, slight inaccuracies are forgiven as theattachment device 400 includes many surfaces with which the aligner canengage.

In FIGS. 7-15, the attachment device 400 is shown engaging the aligner300 to effect a variety of tooth movements. In particular, the aligner300 is shaped to engage one or more surfaces of the attachment device400. Although illustrated as being the aligner 300, any suitablealigner, e.g., an INVASIGN aligner may be utilized. Surfaces of theattachment device 400 are shown as being shaded to indicate whichsurfaces pressure or force is to be applied to effect the describedcorrectional movement of the tooth 102. The direction of the force thatis applied to the shaded areas of the attachment device 400 is indicatedby directional arrows adjacent thereto. It is noted that referring backto FIG. 6, each of the surfaces of the attachment device 400 is labeledwith a reference character. The desired final position of the teeth 102is illustrated in FIGS. 7-15 in a phantom, dotted line and the initialposition of the teeth 102 is shown in a solid line.

As shown in FIG. 7, the aligner 300 is shown as being engaged with theattachment device 400 to effect a force(s) upon the surfaces 404A and404B of the attachment device 400. Over time, as the aligner 300 pressesagainst particular ones of the surfaces of attachment device 400, forcesare applied to the tooth 102 to which the attachment device 400 issecured. In FIG. 7, the surfaces 404A and 404B are shown as being shadedto indicate that these surfaces are being pressed against by the aligner300. The force(s) that are applied to the surfaces 404A and 404B effectan extrusion force upon the teeth 102 as indicated by the upwarddirectional arrow in FIG. 7.

As shown in FIG. 8, root angulation movement of the tooth 102 is alsoachievable. For example, force may be applied to surfaces 403A and 406Band another force can be applied to surface 404B and 406A about a centerof rotation such that a pivoting force in a first direction, asindicated by the illustrated directional arrow, is applied to the tooth.Application forces to surfaces 403B and 406A and another force tosurfaces 404A and 406B about a center of rotation may effect a pivotingforce in an opposing second direction. It should be understood that rootangulation movement may also have a corresponding movement of theangulation of the crown of the tooth and vice versa.

Also for example, as shown in FIG. 9, a lateral movement or translationmay be effected by applying a force to surfaces 404A and 403A in a firstlateral direction or a force to surfaces 404B and 403B in an oppositelateral direction. The stretch of the plastic of which aligner B isfabricated allows the aligner to seat on the existing tooth position byelastically distorting to the current location/orientation/shape of thetooth. The material memory within the plastic trying to reform to itsfabricated shape is what applies the force. A traditional attachment hasa single face to capture the movement of the aligner. The attachmentpresented here has two faces to meet the surface of the aligner which isdelivering force for movement. Two orientations for the beveled face tocapture this force provides more “give” if the aligner does not seatfully and increases the surface area available compared to onetriangular beveled face; as in a traditional attachment.

A root angulation of the movement of a tooth was described above withreference to FIG. 8. By way of illustration, root and crown angulationof a tooth are now also described with respect to FIGS. 10 and 11,respectfully. For example, as shown in FIGS. 10 and 11, the tooth 102may also be rotated or angled about a pivot point R1 or R2,respectively. In particular, to effect a movement of root of the toothas shown in FIG. 10 by the directional arrow, forces as applied in thedirection as indicated by the directional arrows adjacent to thesurfaces of the attachment device 400 may be applied to the surfaces ofthe attachment device 400 that are shaded. In particular, as shown inFIG. 10, forces may be applied to surfaces 403A, 303B, 404A, 406B, and404B. A downward force may be applied to the surface 406B, an upwardforce may be applied to the surface 404A, and a force that is orientedin a direction orthogonal to those forces may be applied to a portion ofthe surface 404B. The combined effect of these forces would be to causethe tooth 102 to pivot about pivot point or axis R1. In contrast, asshown in FIG. 11, forces may be applied against at least a portion ofsurfaces 404A, 406B, and 404B as indicated by the shading anddirectional arrows to effect rotation of the tooth 102 about a pivotpoint or axis R2.

It would be readily understood by a person of ordinary skill in the artthat desired movements of the teeth can be achieved by configuring theappliance 300 or the like to have appropriate negative impressions 302formed in the appliance 300 that when the appliance 300 is placed uponthe teeth 102 that the interaction of the appliance 300 with attachment400 will effect the desired movement. The particularly disclosedmovements are merely illustrative but are not intended to be limiting.For example, when a force is applied to surface 404B and to surface406A, a rotative force on the tooth may result. While FIG. 7 illustratedan example in which extrusion of teeth 102 may be effected through theapplication of force upon various surfaces of the attachment member 400,FIGS. 12-13 illustrated that the attachment member 400 includes opposingsurfaces that can be engaged or acted upon to effect opposite movements.In particular, while applying forces to the bottom surfaces 404A and404B may effect extrusion of the tooth 102 as shown in FIG. 12, applyingforces instead to opposing ones of those surfaces, namely surfaces 403A,403B, 406A, and 406B may effect intrusion of the tooth 102 as shown inFIG. 13. It is noted that as shown in FIG. 15, intrusion of the tooth102 may be effected by applying forces to surfaces 406A and 406B withoutapplying forces to surfaces 403A and 403B as well.

Referring back to FIG. 14, rotation of the tooth from an initialposition (solid line) to a final position (phantom, dashed line) may beeffected by applying forces to the shaded surfaces 403A, 404A, and 406Bto cause the tooth to rotate about its center line CL and also totranslate laterally.

It is noted that the above examples are merely illustrative and thatvarious combinations of the surfaces of the attachment member 400 may beselected for the aligner 300 to engage to effect various forces andcorrectional movements upon the teeth 102.

As already discussed, conventionally, aligner appliances requiresubsequent placement of attachment devices after determining the shapeof the aligner appliance. Here, a scan is performed subsequent toplacement and bonding of the attachment device 400 onto lateral toothsurfaces. The scan may not distinguish between tooth surface and theattachment 400, but may instead consider the tooth and the attachment400 as a single item. Since attachment 400 is registered as toothsurface during the digital scan of the teeth, the clinician has theoption of adding more attachments during software modeling or choosingnot to do so. It is noted that current software such as ALIGNTECHNOLOGY'S INVISALIGN'S CLINCHECK has no capability of knowing ifthere is adequate surface area or morphology on a tooth for theappropriate force delivery of any given aligner. In other words, thesoftware will recognize the attachment 400 as being tooth structure andwill recommend a shape of the aligner 300 to have a configuration thatwill effect the desired forces upon the surfaces of the attachmentdevice 400 (which the software has interpreted as being toothstructure), and any suitable actual tooth surface, to effect the desiredcorrective movements of the teeth 102.

Advantageously, regardless of the ultimate desired correction of a toothposition or angulation, the presently disclosed universal attachmentdevice may be affixed to a tooth. Even in a situation where nocorrective movement of the tooth is needed, the presently discloseduniversal attachment device may be affixed to the tooth. Thereafter, adetermination of the desired corrective movement of the teeth may bemade whether manually by an expert's examination of the patient or byutilizing software such as that described herein. This is a tremendoustime saver as compared to the conventional methods in which anattachment must be customized for each and every tooth. As discussedabove, the conventional methods are also inaccurate becauseconventionally a scan of a tooth occurs prior to the placement ofconventional attachments and a corresponding custom aligner is generatedwithout factoring in for the possibility that during the affixation ofthe customized conventional attachment devices there may be excessmaterial (e.g., flash or bonding material) which would mean that thealigners and the customized conventional attachment devices do notinteract as expected and the resultant corrective movement of the teethmay be less than ideal. In contrast, the present disclosure providesattachment devices that can be secured or affixed to the teeth prior todetermining the configuration of a corresponding aligner. This greatlyincreases time efficiency and accuracy resulting in reduced time fortreating the patient and a better result.

Having described at least one of the preferred embodiments of thepresent disclosure with reference to the accompanying drawings, it is tobe understood that such embodiments are merely exemplary and that thedisclosure is not limited to those precise embodiments, and that variouschanges, modifications, and adaptations may be effected therein by oneskilled in the art without departing from the scope or spirit of thedisclosure as defined in the appended claims. The scope of thedisclosure, therefore, shall be defined solely by the following claims.Further, it will be apparent to those of skill in the art that numerouschanges may be made in such details without departing from the spiritand the principles of the disclosure. It should be appreciated that thepresent disclosure is capable of being embodied in other forms withoutdeparting from its essential characteristics.

What is claimed is:
 1. A universal attachment device configured to be secured to a tooth for engagement with a removable dental positioning appliance, comprising: a mounting surface configured to be secured to the tooth; and an attachment surface, the attachment surface generally opposing the mounting surface and including a plurality of movement faces, each of the plurality of movement faces being configured to interact with the removable dental positioning appliance, the interaction of the removable dental appliance with each of the plurality of movement faces effecting a force upon each of the movement faces, the force having a magnitude and a direction, wherein at least one of the movement faces interacts with the removable dental appliance such that the force applied to the at least one of the movement faces has a magnitude that is substantially zero and at least another one of the movement faces interacts with the removable dental appliance such that the force applied to the at least another one of the movement faces has a magnitude that is greater than zero.
 2. The universal attachment device of claim 1, wherein an application of a combination of forces upon particular ones of the plurality of movement faces results in a net force upon the tooth to effect a desired repositioning movement of the tooth when the attachment device is attached to the tooth and the removable dental positioned appliance is engaged with the attachment device.
 3. The universal attachment device of claim 1, wherein the attachment surface is generally planar and each of the movement faces is angled with respect to the attachment surface.
 4. The universal attachment device of claim 1, further comprising a first prism, the first prism being defined by at least a first portion of the plurality of movement faces.
 5. The universal attachment device of claim 4, further comprising a second prism, the second prism being defined by at least a second portion of the plurality of movement faces.
 6. The universal attachment device of claim 5, wherein the first prism and the second prism define a 45-degree angle therebetween and define a V-shape, the first prism and the second prism having a common first end, each of the first prism and the second prism extending lengthwise from the common first end.
 7. The universal attachment device of claim 6, wherein the first and second prisms are symmetrically disposed relative to one another along an axis bisecting a side of the mounting surface.
 8. The universal attachment device of claim 7, wherein the mounting surface is configured as a square shape.
 8. The universal attachment device of claim 6, wherein each of the first prism and the second prism include three of the plurality of movement faces, each of the movement faces of the first and second prisms being angled relative to one another.
 9. A universal attachment device, comprising: a V-shaped prism comprising: a first movement face and a second movement face, the first and second movement faces extending along a first axis, the first movement face and the second movement face being angled with respect to one another; a third movement face and a fourth movement face, the third and fourth movement faces extending along a second axis, the third movement face and the fourth movement face being angled with respect to one another, the first axis and the second axis defining an angle therebetween; a fifth movement face, the fifth movement face being disposed at a first end of the V-shaped prism, the fourth movement face being angled with respect to first and second movement faces; and a sixth movement face, the sixth movement face being disposed at a second end of the V-shaped prism, the first and second ends of the V-shaped prism being symmetrically positioned with respect to an axis bisecting the V-shaped prism, the sixth movement face being angled with respect to the third and fourth movement faces.
 10. A method for correcting tooth positioning, comprising the steps of: providing a universal attachment device, comprising: a V-shaped prism comprising: a first movement face and a second movement face, the first and second movement faces extending along a first axis, the first movement face and the second movement face being angled with respect to one another; a third movement face and a fourth movement face, the third and fourth movement faces extending along a second axis, the third movement face and the fourth movement face being angled with respect to one another, the first axis and the second axis defining an angle therebetween; a fifth movement face, the fifth movement face being disposed at a first end of the V-shaped prism, the fourth movement face being angled with respect to first and second movement faces; and a sixth movement face, the sixth movement face being disposed at a second end of the V-shaped prism, the first and second ends of the V-shaped prism being symmetrically positioned with respect to an axis bisecting the V-shaped prism, the sixth movement face being angled with respect to the third and fourth movement faces; affixing the universal attachment device to a tooth; determining a combination of the first movement face, the second movement face, the third movement face, the fourth movement face, the fifth movement face, and the sixth movement face to which to apply a force to effect a tooth movement.
 11. The method of claim 10, wherein the combination is a first combination that effects the tooth movement, the tooth movement being an extrusion of the tooth.
 12. The method of claim 10, wherein the combination is a second combination that effects the tooth movement, the tooth movement being an intrusion of the tooth.
 13. The method of claim 10, wherein the combination is a third combination that effects the tooth movement, the tooth movement being a lateral movement of the tooth.
 14. The method of claim 10, wherein the combination is a fourth combination that effects the tooth movement, the tooth movement being a rotation of the tooth.
 15. The method of claim 10, wherein the combination is a fifth combination that effects the tooth movement, the tooth movement being a root angulation movement of the tooth.
 16. The method of claim 10, wherein the combination is a sixth combination that effects the tooth movement, the tooth movement being a crown angulation movement of the tooth.
 17. The method of claim 10, wherein the combination is a seventh combination that effects a root angulation and a crown angulation.
 18. The method of claim 10, wherein the step of determining occurs after the step of affixing. 